Medical technology has created the expectation that there be an ability to “instantly” transmit critical patient clinical and demographic information between medical and other healthcare entities. A surgeon or other specialist is often waiting for critical patient clinical information in order to make potentially life saving decisions regarding a patient's immediate medical care. Often this clinical information is requested to be sent “stat”, the term meaning that the information is being required immediately to make medical treatment decisions.
In the case of many electronic format medical images, such as radiological images, the large data files are can take significant lengths of time to electronically transmit to the treating physician's location. Also, Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations, as well as proper professional practice, demand that this information be transmitted in a manner that maintains patient privacy and in a manner that assures that the data is securely and reliably transmitted, all without compromising the need to transmit the data as soon as possible.
There are numerous challenges in the implementation of such systems. Although broadband digital connectivity is becoming more readily available, and at affordable costs, this connectivity is usually not secure, sometimes unreliable, and in many cases still too expensive to utilize and still allow a medical practice to operate profitably in the current era of diminishing health maintenance organization (HMO) reimbursements and skyrocketing medical insurance costs. There exists an immediate need for a healthcare entity-to-healthcare entity communications solution that meets the following requirements.
This solution should preferably be: (i) secure enough to meet both HIPAA privacy and security guidelines; (ii) fast enough to deliver data to meet “stat” demands; (iii) reliable enough to assure delivery at any time or day of the week; (iv) affordable enough for even the smallest medical practice in the most economically depressed areas of the country; (v) easy to install, maintain and monitor so that practices without information technology (IT) departments can utilize the system without taking on the additional costs of staff technology employees or having to purchase expensive outside technology support; (vi) robust enough to allow the medical practitioners to feel comfortable that the transmission method will provide reliable medical data delivery; (vii) “technology flexible” in order to allow for and utilize the various types of data connectivity that are regionally available including, but not limited to, digital subscriber lines (DSL), cable modem services, fractional and full bandwidth frame relay lines, integrated services digital network (ISDN) lines, point-to-point direct connect lines, satellite based communication services (e.g., those offered by Hughes Digital), dial-up services (although usually too slow for efficient larger digital image transmissions), and other services currently available and planned for the near future; (viii) easily upgradeable to accommodate newer and faster connectivity as it evolves with a minimal amount of technological obsolescence; (ix) based on non-proprietary and easily available proven transmission technologies; and (x) flexible enough to accommodate all types of healthcare related information and data including, but not limited to all size and format radiological Digital Imaging and Communications in Medicine (DICOM) standard images and other digital exam studies and images, all digital medical images from, and/or for, all medical specialties, digital video studies and reports as required, medical reports, dictated voice files in wave, MP3 and other formats, scanned patient information such as insurance cards, prescriptions, and all other pertinent patient data, insurance records and capitation information, medical histories and other historical, medical and demographic information, and virtually any information that needs to be moved from healthcare entity to healthcare entity in a manner that meets all of the above required restrictions. There currently exists no system which satisfies all of the above needs.
One example of a field which relies upon medical images is the radiology field. In the past, if a referring physician needed to view a patient's radiological exam images on a “stat” basis, the method of getting these images to the doctor followed an antiquated procedure which included; producing additional copies of hard-film X-rays, CT or MRI images (an expensive process) and sending them via messenger or courier service (another expensive process) from the imaging center to the doctor's office. If the two locations were in the same neighborhood, this procedure was often the only solution, and it has been used for years. If the two locations were distant, an overnight courier service (also expensive) was utilized.
The recent conversion of many radiology imaging centers from film-based modalities to digital DICOM compliant modalities now allows for the creation of digital radiological images. While less expensive to produce and manage than film, these digital images and studies must somehow still be delivered to the referring physician in a speedy and cost effective manner. Current technology has permitted the development of two new improved methods of moving this medical information, both of which have addressed only some of the earlier issues and concerns.
The first method entails the producing of a CD containing the patient's images and usually some type of viewer that can then be used by the referring physician to view and analyze these images. It is far less expensive and much quicker to burn an exam CD for less than $1.00 than it is to produce copies of hard-film studies. It is also much more convenient for the doctor to file the small CD in the patient's file jacket than it is to store large, cumbersome and bulky film studies. However, the problem of speedy delivery to the referring physician still exists and is currently solved by the traditional method of courier, messenger or overnight delivery service.
The second new method of making the radiological information available to referring physicians entails making the images (and sometimes other information) available on a web-based server and then giving the doctor the ability to securely login and view this information from a remote location. U.S. Pat. No. 5,920,317 to McDonald discloses such a system and method for storing and displaying ultrasound images. The system includes a networked series of computers 26, 22, 24 with ultrasound images being stored on a server side in a compact disk changer/player 28. The ultrasound images may be accessed and viewed through an ultrasound image review module executing on a remote computer 26 in communication with the server 24 through a WAN 34, such as the Internet. Another of these types of systems is distributed by DR Systems, Inc. under the name “Web Dominator”. The “Web Dominator” is a software product which allows a PC to be used as a remote terminal which allows for the downloading of exam images via VPN or SSL.
While these systems and methods address some of the existing concerns, such as potentially dealing with the speedy delivery issue (depending on the doctor's Internet connection speed), they do so at an often-unacceptable cost in other areas. All of these systems operate by allowing a user to log on to a server via a communications link and then to request download of desired images. Even when the user has a fast communications link, however, due to the often huge size of the images, download can take a significant amount of time. It is, of course, possible to compress these web-published images in order to make them smaller so as to speed download time. However, in order to make download time acceptable, the images typically must be compressed to a degree that makes them of too low a resolution to perform a primary diagnostic read. While this is sometimes acceptable, since the referring doctor sometimes depends on the diagnostic radiologist to perform this function and only requires the images for referral purposes or to show to a patient, it is obviously not an optimal solution. Certain specialties, such as orthopedic surgeons, cardiologists, neurosurgeons and some others usually require the high-resolution original radiological images to perform their procedures with any level of confidence.
As such, what is desired is a system which does not require a user to choose between waiting for an extended period while an image downloads or sacrificing image quality. More specifically, what is desired is a system which provides high quality, images to a user without requiring compression resulting in image degradation and without requiring that a user request to view an image and then wait an unreasonably long time for the requested image to be downloaded.